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SELF-ASSESSMENT QUESTIONNAIRE
GENERAL INFORMATION
DATE:
NAME OF COMPANY:
PANAMERICANA NORTE KM 30
PUENTE PIEDRA- LIMA- PERU
TELEPHONE NUMBER:
5484848 / 5481020
FAX NUMBER:
5484848 Anexo 58
GENERAL MANAGER
e- mail:
PRODUCTION MANAGER
e- mail:
COMMERCIAL CONTACT
e- mail:
TECHNICAL Q/A MANAGER
e- mail:
Who does the technical Q/A
manager report to:
jackerman@aglisac.com.pe
ING. GERARDO GARLAND GHIO
ggarland@aglisac.com.pe
Sr. MAURICE WINTER
mwinter@aglisac.com.pe
Lic. ERICK AGURTO GUERRERO
eagurto@aglisac.com.pe
PRODUCTION MANAGER: ING. GERARDO GARLAND
GENERAL PRODUCT
PROCESSED/PACKED:
APPROX. TONNAGE PER YEAR:
GENERAL POLICY
A Does the company have a Quality Policy?
B Does the site possess any external accreditation (e.g. British
Retail Consortium (BRC), ISO, etc.)?
If yes name:
B Is there a supplier check procedure for:
(i)
Raw Material (agriculture suppliers)?
(ii)
Purchased goods?
C Is a Hazard Analysis and Critical Control Point (HACCP)
system in operation?
If no, is an HACCP system being prepared?
D Are Flow charts available for all products?
E Is a Code of Practice or Operational Manual in use?
F Are specifications applied to all products
AGRICULTURE CONTROLS
A Are Soil Samples taken for analysis from the fields before the
crops are grown?
B Are Field Records kept for all treatments to the crops?
C Does the company have contracts with the Growers (suppliers
of Raw Material)?
D Does the company operate a Genetically Modified Organisms
(GMO) Free Policy
E Does the company operate an Irradiation free policy?
F Does the company operate an Integrated Crop Management
System?
G Does the company carry out screenings for pesticide residues?
(Maximum Residue Levels [MRLs])
H If yes, how often are these screenings carried out?
Answer: twice at month
I Please name the Laboratories used for the Pesticide Residue
Screening:
Answer: INSPECTORATE
YES
NO
X
X
X
X
X
X
X
YES
NO
X
X
X
X
X
X
TRACEABILITY
A Is there a trace back system?
B How for can you trace back?
(i)
Day of production
(ii)
Group of farmers
(iii)
Farmer and field
C Coding system
Can you indicate how products are coded? (provide example)
(i)
Raw material
(ii)
YES
NO
X
X
(ii)
(iii)
(iv)
(v)
YES
NO
Non-Ferrous?
(iii)
Stainless Steel?
GLASS
A Do you have a Glass and Hard Plastic policy?
Does the policy have a procedure for dealing with breakages?
B Is there a Glass and Hard Plastic Control book where all the
Glass and Hard Plastic in the factory is checked and recorded?
C Are lights protected?
WOOD
A Is wood used in the production area?
B What controls do you have in place to prevent wood entering
the product?
PROCESSING CONTROLS
YES
NO
YES
NO
Outside grounds
PEST CONTROL
YES
NO
YES
NO
PERSONNEL HYGIENE
Are there written company hygiene rules?
(i)
Are there notices for these rules (signs on walls and doors
indicating hand wash or non smoking, etc. )?
B
C
D
E
F
G
H
I
J
(ii)
Do the rules apply to visitors and contractors?
(iii)
Are staff trained in personnel hygiene?
(iv)
Are training records kept?
Is there pre-employment medical examination?
Is there a pre-employment medical questionnaire?
Is there an illness record book?
Is there a separate first aid room?
Are blue plasters with metal strip used?
Protective clothing
(i)
Is protective clothing provided?
(ii)
Does every employee have is own clothing locker?
Are hand washing facilities placed at each personal entrance?
Are disposable gloves used and controlled?
Are canteen facilities provided?
YES
NO
10
PRODUCT QUALITY
YES
NO
YES
NO
YES
NO
11
CONSUMER COMPLAINTS
A Is there a follow up procedure?
B Are management informed?
C Is there an action plan to solve complaints?
12
13
YES
NO
Signature:
Date: